Analyzing a patient’s history

 

 

 

T​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​he information stated below is to help answers the questions below. History of patient: 7-year-old male brought in for assessment, patient is accommodated by his mom in which she wants him evaluated for his behavior at school and home. Mom states that the patient often worries that she will die, or she won’t pick him up from school. Patient also feel mom loves his brother more than him. Still wets the bed even with medication that treats this issue. He is easily distracted at school, often bullied by his peers and throws things when he is mad/upset at home/school. Unable to focus at school. Feels that his mom and brother will not come home, patient has been dealing with this since his father never came back home. The mother further stated that dad died while being deployed for the military when he was 5 and she didn’t know how traumatic that conversation would be for him, so he told him that dad went on vacation and just never returned. The patient still looks for his dad, mom feels that this is all her fault and she is unsure how to move forward as he continues to ask questions about his dad and is fearful of her and his sibling leaving him. Diagnostic Impression: (these are the 3 diagnosis that I came up with for this patient with Separation anxiety being my number 1 diagnosis. Separation anxiety (accurate diagnosis) Generalized Anxiety disorder Munchausen’s syndrome Please answer these questions below based on the information and diagnosis stated above. What were your differential diagnoses? They are listed above. Provide a minimum of three possible ​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case. What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy. Reflection notes: What would you do differently with this patient if you could conduct the session again? Discuss what your next intervention would be if you could follow up with this patient.?Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion, and disease prevention, taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.). Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years ​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​old).

Sample Solution

Patient is a set of details collected  from patients and other relevant sources on the possible course of their current illness. It is an integral component of a clinical encounter. Gathering information about medical history is critical for accurate and effective decisions. It is also an important tool in successful physician-patient interactions. A good patient history decreases the burden of an unnecessary laboratory test and healthcare expenditure. This article discusses different components of the patient history and highlights its importance in the accurate diagnosis of an illness. Patient history consists of various components that are useful to  explore relevant  information about the  progression  and  subsequent  evolution  of  the disease

growls and gasps’ however I struggle to hear these sounds when listening to Shostakovich’s only opera. In Act 4, when Katerina and Sergei are on their way to the labour camp in Siberia, Katerina has several extremely lyrical and almost hypnotic phrases. She sings to Sergei, telling him how much she misses him, to which he replies saying ‘That you have ruined me’ , blaming her for ending up as a convict, heading off to a labour camp. Katerina begs for his forgiveness, reaching for a top B flat, joined by a fortissimo chord in the winds. One of the sections that makes the audience really empathise with Katerina is from Figure 527 onwards. She has just discovered about Sergei and Sonyetka’s tryst and is jeered at by her fellow prisoners; ‘Katerina what a dreadful mess you made of life! And without Sergei her life is oh so dreary!’ . What follows is a lament, sung by Katerina where she sings about the lake in the forest in which she pushes Sonyetka. Katerina’s lyrical melody is accompanied by pianissimo, muted sustained chords in the Upper Strings, with a tremolo pedal note in the Cellos and Basses. The Harp, Timpani and Bass Drum also play a similar part to the Lower Strings with the same pedal note in the former two instruments. In between Katerina’s phrases, the woodwinds play a dotted rhythm, which is eventually taken over by the harp and viola section. Katerina’s melody from Figure 527 is quite low in the soprano register, until she sings ‘and its water is black as oil, like my guilty conscience’, with an E flat when she sings guilty. As this is the highest note she has sung until this point, its rings out, and leads the audience to believe Shostakovich’s view on Katerina, that she was a product of her environment, that she was ‘a loving woman, a woman who feels deeply’ . She feels remorse for her actions however is still pushed towards her final action. Even this isn’t a decision Katerina takes lightly and sings ‘I am frightened!’. Women under the Soviet Union The February 1917 Revolution is generally agreed to have begun on International Women’s Day (23rd February) ‘when thousands of women from different backgrounds took to the streets demanding bread and increased rations for soldiers’ families’. When the Bolsheviks came into power in Russia in November 1917, they ‘wanted to recreate society completely’ by creating an equal society, where each individual had equal rights. This meant that women would have a more equal standing in society. They would be expected to have jobs outside of their homes, in the workforce. In October 1918, the government issued a code called the ’Family Code’, which allowed women the right to a divorce, separated marriage from the church and gave illegitimate children the same rights as legitimate children. In 1920, abortion was legalised in the Soviet Union. Laws in the workplace were also changed to help women- women were able to take paid holiday, 8 weeks paid maternity leave and the minimum wage was standardised between genders. To oversee these changes, a department called Zhenotdel was set up in 1919 and it was a specialist women’s department. However, unfortunately, things changed during the Stalinist era (1927-1953). The Communist Party’s Purges, targeted women and they were sent to work labour camps. The number of women in the Labour Camp system rose from 30,108 in 1934 to 108,898 in 1940. In the camps, they were expected to work in sewing factories and many were unfortunately the victims of violence and sexual abuse. Stalin in fact reverted some of the changes that had been made under Lenin. For example, in 1936, he banned abortion again. He also made it harder to get a divorce, by making them quite expensive to obtain. Stalin ‘put the emphasis on the family as a basic unit of society. He thought that having strong families would produce a stronger and more productive so

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